Research Spotlight: New Study Motivates Smoking Cessation via a Virtual Reality Headset during Dental Cleanings

GSDM Center for Behavioral Sciences Research Director Dr. Belinda Borrelli and her team are entering the fourth year of a five-year grant testing if virtual reality technology to deliver smoking cessation information during dental cleanings will encourage both motivated and non-motivated smokers to try treatment. (Photo Credit: Dan Bomba, GSDM)

 

How do you motivate a smoker to quit smoking if they don’t want to change their habits? Where is the best place to present smokers with effective quitting information? What new and innovative technologies can increase smokers’ motivation and confidence?  

These are the questions GSDM Center for Behavioral Sciences Research Director Dr. Belinda Borrelli has been trying to answer in her work for more than 25 years.  

“Somebody who doesn’t want to quit isn’t going to go someplace that they normally don’t go, and they’re not going to want to spend extra time getting counseling,” Borrelli said. “Even if they get counseled at the dentist, they don’t want to sit there for longer than they should, [especially] if they’re [not previously motivated] to quit.” 

Borrelli and her team are entering the fourth year of a five-year grant exploring whether a video shown to a patient through a virtual reality headset while they are getting their teeth cleaned – in combination with a customized text message program – is effective at encouraging smoking cessation. 

Borrelli is the grant’s principal investigator and is joined on the project by co-investigators Marianne Jurasic (GSDM), Romano Endrighi (GSDM), Howard Cabral (SPH), and Lisa Quintiliani (CAMED). The trial is funded by a $4.1 million grant award from the National Institute of Health / National Institute of Dental & Craniofacial Research. Currently, Borrelli’s team has recruited more than 275 patients into a randomized clinical trial, conducted both in the GSDM patient treatment center and at Tufts School of Dental Medicine.  

Smoking remains the top preventable cause of premature death in the United States, and individuals with low income and low educational levels smoke in disproportionate numbers than the rest of the population, according to a 2022 article in BMC Public Health. Smokers with incomes below poverty level and with low education levels are less likely to quit and use cessation interventions than those at or above poverty level, despite having similar motivation to quit. Due to smoking’s effect on oral health, a dental clinic can be a natural way to guide smokers towards evidenced-based smoking cessations treatments.  

“Everybody has ambivalence about a big decision in their life, whether it’s smoking, losing weight, moving, [or] choosing a school,” Borrelli said. “It’s just viewing it as a natural process of change and helping them make the decision for themselves.” 

Cessation interventions are not typically delivered in a dental setting due to both lack of time during dental appointments and insufficient provider time and training on how to work with unmotivated patients, Borrelli said. VR headsets, especially the disposable ones, are a cost-effective and time-efficient way to incorporate smoking cessation guidance into dental appointments, helping providers reach all smokers, regardless of their motivation.  

“I think it’s a struggle because they really want to help the smokers, but they don’t have time or they’re not up on the latest smoking cessation treatments or they don’t know how to motivate an unmotivated smoker,” Borrelli said. “There’s a lot of barriers.”

(Photo Credit: Dan Bomba, GSDM)

In the experiment, smokers are randomly assigned to an intervention group or a control group. Patients in both groups watch videos on a VR headset during a teeth cleaning. Patients in the intervention group watch a cessation induction video, featuring information on various effective smoking cessation treatments. Patients in the control group watch a video on stress management, but don’t receive any information on smoking cessation.

The intervention group is further divided into two groups – smokers who are ready to quit and those who are not ready to quit – to get a “tailored treatment.” In the “Ready to Quit” and “Not Ready to Quit” videos, participants will be presented with content based on their current mindset, hopefully leading to high levels of engagement.  

“If we talk to an unmotivated smoker and we said, ‘This is how you put on the nicotine patch. This is the way that you use different stop smoking medications,’ they would turn off and stop listening, because they [think], ‘I don’t even want to quit smoking and you’re telling me exactly detailed instructions on how to quit,’” Borrelli said. “You’re going to alienate the person if you don’t match their level of motivation.” 

To supplement the videos, Borrelli’s team administers a text-messaging program for four weeks after the participants’ VR dental appointment. Individuals in the intervention group receive a tailored, interactive, and automated text message program to motivate them to use evidenced-based treatments. Participants in both groups receive text messages that include questionnaire-based assessments.  

Borrelli said the videos alone may not be enough to spur smokers to start cessation programs. Text messages are an easy and low-burden way to give smokers additional information and motivational strategies.  

“You need multiple messages over time to be effective,” Borrelli said. “We’re hoping that with extra engaging information that [it] will break some of their myths about smoking and smoking medications.”  

While the study is still being conducted, Borrelli wants to stress that it is never too late to quit. Her goal is to make sure everyone has the proper resources and help they need.  

“If the best-case scenario doesn’t happen, then I want them to quit three months from now rather than three years from now, after more damage is done,” Borrelli said.  

 

By Rachel Grace Philipson